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PubMed1984

Suitability for insight-oriented psychotherapy as a prognostic factor in treatment of phobic women.

Suitability for insight-oriented psychotherapy comprises many factors that may have a positive relation to outcome in individual psychotherapy. We wanted to test the hypothesis that patients suitable for insight-oriented psychotherapy (I patients) improve more than not-suitable patients (NI patients) in non-dynamic therapies. Pairs of phobic female NI and I patients were formed with age, type of phobia, global rating of severity, therapist and type of therapy as matching variables. All women received a simple basal therapy in the form of standardized information, self-exposure instructions and anxiolytic medication. Six pairs received this treatment only, six pairs in addition received relaxation therapy and nine pairs in addition received therapist-directed prolonged exposure in vivo. The patients were rated with regard to symptoms and functions at the start of the treatment, at the termination of treatment 3 months later, and at a 1 year follow up. NI patients were less often married, had a longer duration of their phobias, and had higher initial ratings on aspects of indirect as well as direct manifestations of anxiety, ego restriction, and global severity. I patients improved more than NI patients with regard to aspects of the target phobia, both at the termination of the treatment and at the follow up. Otherwise the outcome was similar. There was no indication of a greater amount of conflict solution in the I patients. The result might be explained by supposed differences in the amount of self-exposure. The hypothesis was supported, but the results cannot be applied to other types of neuroses.

Adult↗
PubMed1985

Agoraphobics and social phobics: differences in background factors, syndrome profiles and therapeutic response.

Seventy-three agoraphobic and 31 social phobic women, all rated unsuitable for insight-oriented psychotherapy, were compared regarding family and personal history, intelligence, personality and factors pertaining to the disorder. The same patients, with 11 men included in the social phobic group, were also compared regarding response to four randomly assigned types of treatment given over a 3 month period, with a 9 months' follow-up. The following differences were revealed: 1) Social phobias were associated with a higher social class of the parental home, higher education, higher scores on verbal intelligence, and a higher social class of the patient. 2) Social phobics scored higher on the personality factor, aggressive non-conformance, otherwise there were no differences in the personality factor. 3) Agoraphobias were associated with mother working outside home during the patient's childhood, neurotic symptoms in childhood, and current economic difficulties. Agoraphobics more often gave experience of death as a cause of the disorder. 4) Social phobias started at an earlier age. 5) Target phobia and the global rating were of equal severity in the two syndromes, but the agoraphobics had higher ratings on free anxiety and depersonalization. 6) Social phobics responded better to prolonged exposure in vivo, while agoraphobics responded better to supportive therapy of dynamic type, or to a simple basal therapy. Social phobics more often wanted the therapists to give advice and guidance.

Adult↗
PubMed1985

Expectancy, covert sensitization and imaginal desensitization in compulsive sexuality.

Twenty subjects were randomly allocated to receive either imaginal desensitization (ID) or covert sensitization (CS) to reduce compulsive anomalous sexual behaviours. It was predicted from a behavioural completion model of compulsive urges, that patients' response to ID would be at least as good as their response to CS and would correlate with reduction in their general levels of tension following treatment. These predictions were supported. Correlations between patients' expectancies of treatment success and their response were of moderate strength for expectancy measures taken following the first session of both treatments, but much stronger for expectancy measures following the last session of ID. It was suggested that patients experienced a specific response during the further sessions of ID, which enabled them to improve their prediction of response. As aversive therapies remain the standard behavioural therapy for sexual paraphilias, the finding of the present study that imaginal desensitization without traumatic imagery or aversive physical stimuli is at least as effective would seem to require urgent replication, if only on ethical grounds.

Adult↗
PubMed1988

Treatment of sex offenders with imaginal desensitization and/or medroxyprogesterone.

Thirty sex offenders were randomly allocated: 10 to receive medroxyprogesterone therapy (M), 10, imaginal desensitization (ID) and 10 both (ID + M). Twenty-four responded for one year though 3 subsequently relapsed. There were no significant differences in response to the 3 treatments. Four patients who did not respond to the initial treatment and the 3 who relapsed responded to further treatment. Most treated with M maintained heterosexual intercourse at pretreatment frequency. Self-reported reduction in anomalous sexual urges in patients receiving M correlated with reduced testosterone levels one month following treatment, demonstrating that the response was specific and validating the assessment by patients' self-reports. Where cost-effectiveness or time constraints are factors influencing treatment of sex offenders, one of these therapies warrants consideration.

Adolescent↗
PubMed1986

Reduction of dental fear: psychophysiological correlates.

EMG, HR and SCR were continuously recorded during two Standardized Dental Examinations (SDE) of 15 dental phobics. Following the first SDE, the patients were assigned to two treatment groups, one receiving systematic desensitization followed by two separate amalgam restorations and one premedicated with Valium for the two restorations. The dentist rated the patients' behavior on a 5-point scale. Corah's Dental Anxiety Scale (DAS) was used prior to the first SDE and following the second SDE. The second SDE was conducted on a separate occasion following the second restoration. No significant correlations were found between any of the physiological measures and either the dentist's ratings or the second DAS or DAS change scores. Significant differences found between the two treatment groups on the dentist's ratings, second DAS, and change scores were not reflected by the physiological measures.

Adult↗
PubMed1991

Reliability and clinical usefulness of psychometric measures in a self-referred population of odontophobics.

Questionnaire responses of 155 self-referred subjects with extreme dental fear were used to evaluate the reliability and clinical usefulness of some psychometric tests used in diagnosis and treatment. The Corah Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory (STAI), and a general Geer Fear Scale (GFS) were filled out by all subjects, while 80 patients with highest dental fear scores were also tested before and after dental fear treatment with the following scales; a Getz Dental Belief Survey (DBS), Dental Fear Survey (DFS), and a Mood Adjective Checklist (MACL). Cronbach's alpha measured internal consistency reliability. SPSS data analyses calculated item-remainder and test-retest correlations. Clinical usefulness of scales was judged by Spearman correlations of initial scores and test score changes after dental fear treatment. All total test scores showed high internal consistency and test-retest reliability. DFS was judged the preferred clinical measure of threatening perceptions of pain or unpleasantness specific to dental procedures. DBS and STAI-State measured confidence in relating with the dentist and situational fear associated with that relationship. GFS, STAI-Trait, and MACL discriminated levels of general fearfulness, anxiety and mood fluctuations that can impact on dental fear.

Adolescent↗
PubMed1994

Group therapy compared with individual desensitization for dental anxiety.

Effects of group therapy (GT) on extreme dental anxiety were compared with individual treatment (IT). Results by scales of dental anxiety, beliefs or trust in dentists, and fear of the next dentist after specialist treatment showed reduced dental anxiety and improved dental beliefs compared with a static control group of 45 patients. The 30 GT patients showed no significant difference in dropouts during training compared with the 68 IT patients, but for patients who completed treatment, GT (n = 24) had greater dental anxiety reduction than IT subjects (n = 60). GT patients required fewer therapist hours per patients than did either of the two IT methods, but time saved in GT did not reach significance over clinical rehearsal IT. Results at 1-yr follow-up after specialist treatment indicated that dropouts were significantly greater in group therapy. Rehearsal IT performed best for sustained dental care behavior. Group dynamics are discussed and suggestions made for effective and efficient group therapy as well as decision making about choice of treatment.

Adult↗
PubMedDate not supplied

Hypnosis compared with group therapy and individual desensitization for dental anxiety.

Effects of hypnotherapy (HT) and self-hypnosis training on extreme dental anxiety in adults aged 19-65 years were compared with group therapy (GT) and individual desensitization (SD) using scales of dental anxiety, dental beliefs, and fear of a next dentist (after specialist treatment). All experimental groups were demographically comparable and showed reduced anxiety and improved dental beliefs compared with 51 control patients. The 25 HT patients did not differ significantly in numbers of dropouts during training compared with the 30 GT patients or 68 SD patients. For patients completing treatment, HT (n = 22) reduced dental anxiety to the same degree as GT (n = 24) and SD (n = 60). HT and SD patients required more therapist hours per patient than did GT, but total dropouts at 1 yr after specialist treatment were significantly greater in HT (13/ 25) than for SD rehearsals (5/34) or SD video (8/32), but not GT (15/30). Hypnotizability was found to vary from patient to patient, with a direct relationship to time saved. But hypnotizability had an inverse relationship to STAI general anxiety level for those who went on to dentists after 1 year. Transference effects were noted for most HT dropout patients as an aversive response to continued dental treatment with other dentists than the specialist.

Adult↗
PubMedDate not supplied

EMDR: implications of the use of reprocessing therapy in nursing practice.

TOPIC: Eye movement desensitization and reprocessing (EMDR). PURPOSE: To examine the available evidence base for EMDR treatment in psychiatric nursing practice. SOURCES: Evidenced-based research findings, published case and anecdotal reports, and primary source documents on the development of the treatment method. CONCLUSIONS: EMDR use remains controversial. Although it is safe, little is known regarding the mechanism of action of any therapeutic effect; more rigorous empirical establishment of efficacy is needed.

Desensitization, Psychologic↗
PubMed2006

An adult with childhood medical trauma treated with psychoanalytic psychotherapy and EMDR: a case study.

PROBLEM: Adverse childhood experiences have been found to be a strong predictor of emotional and physical problems in adulthood. However, the long-term sequelae for children who have suffered critical illness and exposure to invasive medical procedures are less well documented. METHODS: This is a case study of an adult client who sought treatment for depression and attention deficit disorder. The psychotherapy treatment is discussed and the use of eye movement desensitization and reprocessing (EMDR) is described targeting a memory of a medical trauma resulting from a tonsillectomy when the client was 8 years old. CONCLUSIONS: Significant healing outcomes were attained as a result of the therapy, i.e., decreased depression, less hypervigilance, and increased ability to concentrate, which resulted in the discontinuation of medication for depression and ADHD as well as significant improvement in overall functioning.

Adult↗
PubMed1980

Hyperactivity with tactile defensiveness as a phobia.

Conceptualizing some cases of hyperkinesis (those with tactile defensiveness) as tactile phobias provides the rationale for two unconventional management approaches modeled on the two most popular behavioral treatments of phobia: systematic desensitization and implosion. Both methods are adapted to a nonverbal level, befitting the age of the afflicted children and the nature of the problem. The first method uses the sensory integration techniques developed by Ayres to desensitize the child to touch systematically and gradually. The other method, developed by Henderson and Dahlin, uses restraint and intense tactile stimulation implosively to break through the fear and hyperactive resistance.

Behavior Therapy↗
PubMed2001

Using eye movement desensitization and reprocessing to enhance treatment of couples.

Eye Movement Desensitization and Reprocessing (EMDR) as a clinical technique may enhance treatment effectiveness when applied within a couple therapy approach that is emotionally and experientially oriented. Clinical experience indicates that EMDR-based interventions are useful for accessing, activating, tolerating, and reprocessing the intense emotions that often fuel dysfunctional couple interactions. Using EMDR within conjoint sessions to reprocess negative emotions can amplify intimacy, increase connection, and subsequently lead to a change in problematic relationship patterns.

Adult↗
PubMedDate not supplied

Oral health for people with intellectual disability and high support needs: positive outcomes.

This qualitative study, based on phenomenological approaches, explored and documented four situations in which positive oral health outcomes occurred for people with mental retardation and moderate to high support needs. Strategies and environmental factors that contributed to these oral health outcomes were identified through 10 semistructured interviews conducted with 'key-players' supporting the oral health of the people with disabilities. Participants included dental professionals, direct support workers, and other professionals who cared for their four people with disabilities. Common strategies expressed in the interviews included "giving it a go"; maintaining consistency; facilitating positive experiences; taking as much time as needed; respecting and encouraging choice making; timeliness and frequency of dental appointments; communication between support workers, dental professionals and the person with mental retardation; problem solving; assisting the person with disability to learn skills; and desensitisation. Contributing factors in the physical, social, and organizational environment also were identified.

Adult↗
PubMed1999

A programme for the treatment of severe dental fear. Report of three cases.

This paper describes the use of a sequence of recollection and discussion, training in muscle tone control, dental imagery, audio simulation and graded re-exposure to dental procedures to eliminate a severe fear of dental treatment in three adult female patients. All three patients had abstained from regular dental visits throughout their lives and all were in need of urgent dental treatment when the therapy began. One of the patients also identified in herself other maladaptive behaviour and reported a history of mood disorder as well. The recollections of these patients reveal that the aetiology of dental fear is more complex than dental questionnaires would indicate and, in particular, they supply further evidence of the capacity for adverse medical events to initiate this fear. Although the programme specified in this paper yielded good results, it nonetheless has a number of shortcomings. It is time consuming, dental damage is likely to be well advanced when it commences and it attracts very few patients. Thus those afflicted with severe dental fear are effectively destined for only emergency dental visits and eventually are likely to be edentulous. For this reason every possible precaution against the initiation of dental fear should be taken.

Adult↗
PubMed1977

Attitude change during behavioural treatment of sexual inadequacy.

Attitudes towards 'self' and 'partner' were studied in couples undergoing three different behavioural treatments for sexual inadequacy: systematic desensitization with counselling; guided practice with counselling; and practice with minimal counselling. Factor analysis of semantic differential scales identified five components--general evaluation, anxiety, and three factors relevant to sexual evaluation designated as 'loving', 'sexually attractive' and 'easy to arouse'. Differences in derived factor scores were found which related to sex of rater, identity of complainant, and treatment received; with the treatment combining guided practice with counselling being followed by significantly greater attitude changes.

Anxiety↗
PubMed1981

Comparative credibility of treatment rationales: three tests of expectancy theory.

Previous research has challenged the adequacy of conventional "placebo' controls, by demonstrating that active treatments, such as systematic desensitization, are more credible than supposedly inert control conditions. Such findings give support to the hypothesis that the arousal of positive expectancies is the key to therapeutic change. Three experiments are reported, in which Borkovec's credibility rating method was applied to treatment comparisons modelled upon the findings of outcome research. In the first experiment, systematic desensitization was more credible than rational-emotive and client-centered therapy (P less than 0.001), consistent with an expectancy-arousal explanation of Di Loreto's (1971) comparative outcome study. In the second experiment, Paul's (1966) attention placebo condition was less credible than three active treatments (P less than 0.001). In the third experiment, in vivo desensitization was in some respects more credible than imaginal desensitization, which was in turn more credible in some respects than relaxation alone (P less than 0.001). The results of the latter two experiments were broadly consistent with an expectancy-arousal interpretation of much outcome literature. These results emphasize the insufficiency of merely including a designated "placebo control condition' in outcome research (Kazdin & Wilcoxon, 1976). Credibility differences did not mirror precisely the results of the outcome research on which these studies were modelled, however. Methodological limitations are discussed, and further clinical research is advocated, in which the persuasiveness of treatment rationales is studied in its own right as contribution to treatment efficacy.

Arousal↗